Question of the Week
For June 7, 2016
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Hereditary neutrophiliaBronchiectasisChronic neutrophilic leukemiaChronic use of inhaled budesonideCigarette smoking
Key Learning Point View Case Presentation
The most typical cause of long-standing mild leukocytosis and neutrophilia in a patient with asthma who smokes cigarettes is cigarette smoking.
Cigarette smoking is a common cause of mild leukocytosis, and the more packs of cigarettes smoked per day, the greater the elevation in the absolute neutrophil count. Normalization of the leukocyte count may occur after as little as one year to as long as several years after the cessation of smoking, but may take up to five years. Inflammation related to smoking has been invoked as a cause of neutrophilic leukocytosis, but the exact mechanism is unknown.
Chronic neutrophilic leukemia is associated with neutrophilia and splenomegaly and with blood counts that are likely to worsen over time.
Hereditary neutrophilia is an extremely rare disorder caused by an autosomal mutation in the CSF3R gene, which results in a constitutively active granulocyte colony-stimulating factor receptor. This condition manifests with neutrophilia and splenomegaly.
The patient's stable clinical course suggests that an undiagnosed chronic infection, which can be associated with bronchiectasis, is unlikely.
Inhaled glucocorticoids reduce airway neutrophilia. Systemic high-dose glucocorticoid use can be associated with a mild neutrophilia (average increase in absolute neutrophil count of 4000 per mm3), but this effect is not seen with inhaled glucocorticoids because the systemically absorbed dose is insufficient to affect neutrophil levels.
Last reviewed Jan 2019. Last modified Jan 2019.
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